Page 27 - Sonoma County Gazette June 2019

Puck, the World’s Toughest Cat
Every once in a while we get a patient whose ability to survive against terrible odds reminds us of how amazingly resilient our pets can be.
His name is Puck. He’s a cat of a certain age, neither young nor old, and a sweet-natured charmer. Puck has been “ADR”(ain’t doin’ right) and vomiting for over a month. Five weeks ago, he was examined at an emergency hospital and a complete blood panel was sent to the lab. Puck was given fluids and an anti-vomiting injection and sent home. Puck seemed to do fine at home.
But then the blood test results came in, and here’s where it gets interesting: Puck’s white blood cell count was nearly 23,000. Cats can be normal up to 16,000, but the majority of cats have white cell counts in the 8,000 to 12,000 range. The white cell type that was increased were Puck’s neutrophils, which typically rise in response to stress, inflammation, and, most commonly, to infection. Puck’s blood chemistries were normal except for an increase in his blood glucose, a fairly common sign of stress.
What to do? Since Puck was doing so well after treatment, it was decided to just keep an eye on him. Puck is a garden hunter. Maybe he ate a bad gopher.
And yet... 23,000 is a LOT of white cells. The whole picture seems just too... too.
Fast forward five weeks and Puck is back at the emergency hospital. He’s lost half a pound and now he’s vomiting and has diarrhea.
His temperature is sub-normal, and he’s dehydrated. He receives more symptomatic treatment with fluid therapy and an anti-vomiting injection. He’s started on antibiotic pills, but only has time to receive one dose. Another blood panel is drawn.
This time the blood test results are REALLY interesting, SCARY interesting. Puck’s white cell count is up to 44,500 and he’s left-shifted—meaning he’s calling in immature neutrophils to handle a problem that he can’t otherwise manage. 44,500 is a LOT of white cells. This is the kind of thing that happens when someone has a big, big infection, like a pyometra—a uterus full of pus, or pyelonephritis—a kidney full of pus, or prothorax—a chest cavity full of pus. Are we seeing a pattern here?
Even worse, Puck’s blood albumen (the serum protein that makes fluid stay inside of blood vessels) is sub-normal, his kidneys aren’t working well, and his blood electrolytes are outside of the normal range. Puck is in serious trouble.
Such is the state of Puck’s health when he shows up on our hospital doorstep at 9 AM.
The loss of albumen is key: Without albumen, the IV fluid Puck has been given will not stay inside his blood vessels, and instead seeps into the space between his cells. His blood pressure and circulation are compromised (so his kidneys can’t work properly). Where has Puck’s albumen gone? It has seeped out of his blood vessels because his capillary lining cells are separating. Puck’s circulatory system is literally falling apart. He’ll be dead in a matter of hours, but that doesn’t stop him from purring.
This is S.I.R.S.—Systemic Inflammatory Response to Stress. When inflammation is severe enough, toxic changes damage vascular integrity and initiate a rapid series of changes that ultimately end in capillary leak syndrome and death. Conventional fluid therapy, a mainstay in the treatment of shock,
is ineffective because the fluid doesn’t stay inside blood vessels where it’s needed. Puck’s body is soggy with fluid, but his circulation isn’t improved and more fluid will make him worse, not better.
So, here we are. The patient is actively and rapidly dying and there is no clear diagnosis to explain why, or even to guide us along a path towards his recovery. All we have are themes and suspicions. What a fine way to start the day! What to do?
One thing is certain: The living are much easier to help than the dead. Puck has strong suggestions of overwhelming infection, so he is started on combination antibiotic therapy by injection (because he can’t be trusted to absorb pills), which should at least slow things down. But what to do about the S.I.R.S.?
Welcome to my world.
Tune in next month for the answers to all of Puck’s questions!
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